Mark S. Kim, MD

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

MD00038816 Issued in WA

Practice address

1803 S Meridian
Puyallup, WA 98371

Phone

(253) 268-3400

Fax

(253) 268-3870

NPI assigned

Sep 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Vascular Surgery

Education

Baylor College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bremerton Vascular Imaging LLC

  • Clinic/Center
  • Bremerton, WA
  • NPI 1104773126
  Medicare reassignment
• Eterna Vein & Medical Aesthetics, PLLC

  • Vascular Surgery Physician
  • Puyallup, WA
  • NPI 1366785685
  Medicare reassignment
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Auburn, WA
  • NPI 1043365257
  NPD
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Seattle, WA
  • NPI 1245385467
  NPD
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Federal Way, WA
  • NPI 1518012608
  NPD
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Port Angeles, WA
  • NPI 1639776842
  NPD
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Bothell, WA
  • NPI 1750436945
  NPD
• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Yakima, WA
  • NPI 1831245836
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1053403634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 S MERIDIAN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717513",
            "telephone_number": "253-589-6573",
            "fax_number": "253-984-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 S MERIDIAN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "98371",
            "telephone_number": "253-268-3400",
            "fax_number": "253-268-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MARK",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00038816",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "WA",
            "license": "MD00038816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8255697",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hyewon Kim
• Jessica Kim, MS, RDN, CD
• Jessica H Kim, MD
• Jiyoung Kim, LSWAIC
• June Kim, MD
• Minwoo Kim, DDS
• Myung Sook S Kim II
• Raychel Lyn Kim, OD
• Rebecca Danbe Kim, PHARMD
• Sarah Kim

• Phlebology Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Phlebology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.